EDITORIAL

Yodi Mahendradhata Adi Utarini(1*)

(1)&nbsp (*) Corresponding Author

Abstract

Over 1700 participants from over 100 countriesattended the Second Global Symposium on HealthSystem Research in Beijing from October 31 toNovember 3, 2012. The Symposium discussed stateof-the art health system research and strategies forstrengthening health systems research through keynotes,plenaries, concurrent sessions, satellites,posters, films, informal discussions and debates.One of the symposium sessions presented aconceptual framework for health system researchwhich encompasses systems at macro-, meso- andmicro- levels. Health service research was depictedat the meso- and macro- level of the systems, andmanagement research was noted as part of thehealth service research domain. Thus, health servicemanagement was viewed as a part of the overallhealth system research domain.The panelists highlighted that there are importantdifferences between research to support policymakingat macro-level and research to support managementdecision making. They first emphasizedthat the nature of the evidence required would differ,depending much on whom the evidence is supporting,e.g. goverment official, hospital manager, healthprofessional, citizens. Second, they noted that itwould also be different depending on whether we aresupporting them: (1) to select which programs, servicesand drugs to fund; or (2) to strengthen governance,financial and delivery arrangements withinsystems.They further argued that decisions about servicesand programmes are typically a single decisionmade at a single point in time by a clearly defineddecision-maker as part of routine decisionmaking. In contrast, policy making decisions aretypically consisted of a number of heterogenousdecisions, made over a long period of time, by abroad range of different decision makers, with littleor no routinization. They also highlighted that thebenefits, harms and costs of programs, services anddrugs are less context dependent, while the prosand cons of policies at macro-level is much morecontext dependent. Hence, in health policy research,local tacit knowledge, views and experiences mattermuch more.The debate described above represents an effortto clarify the boundaries of health system research,health policy research and health serviceresearch. There are however critical issues whichneeds to be examined further, particularly in the interestof health services management research.Firstly, it is rather misleading to portray health servicemanagement decision as typically technical,routine and clear cut. The health service managementdecision spectrum arguably spans from completecertainty in one end to absolute ambiguity onthe other end, and many in between. There can bepolitical dimensions to these decisions, eventhoughthey are at the organization or sub-organization level,as they often entail allocation of scarce resources.Thus, there are considerable rooms for local tacitknowledge, views and experience as well withinhealth service management research. Secondly,many management interventions are also contextspecific. A management decision to adopt clinicalpathway may lead to significantly better clinical outcomesin one hospital, but may result in minuteimprovement of clinical outcomes in anotherhospital.Thus, it is too risky to emphasize that healthservice managementdecisions are not so much influencedby context. Health service managementresearchers who fail to discuss contextual matters,may risk having their results haphazzardly generalizedor replicated. These points suggest that importantcharacteristics of health service managementresearch have not been adequately considered inthe symposium discourse above.The relative neglect of health service managementresearch in the current discourse reflects thelack of active contribution from health service managementresearchers, and perhaps also reflects thenature of a field which has not been much well developedscientifically. This calls for efforts to strengthenhealth service management research as a scientificfield. Drawing from efforts to strengthen health systemresearch as a field, we can think of several possibleways to do this. First, we need to establish acommon language by developing authoritative textbooks,journals and courses in health service managementresearch. Secondly, we need to promotecross-disciplinary learnings as heallth service managementresearch is typically multidisciplinary. Third,we need a society for health service managementresearch at national and international level. Fourth,we need more professors, authoritative scientific leaders,in health service management research.98  Jurnal Manajemen Pelayanan Kesehatan, Vol. 15, No. 3 September 2012Yodi Mahendradhata & Adi Utarini: What do we mean by health service ...JMPK, the Indonesian Journal of Health ServiceManagement, remains committed to contributetoward strengthening health service managementresearch by providing an accessible common peerreviewedplatform for state-of-the art health servicemanagement researches since more than a decadeago. We have attempted to make JMPK as accessibleas possible by providing online access to publishedcontent. We will soon expand further by providingpossibility for online submission as well.However, we are still left with the absence ofauthoritative textbooks and society of health servicemanagement research community in the country, incontrast to what we have in epidemiology or clinicalresearch for instance.In the field of epidemiology,there is the International Epidemiological Associationwhich publishes the International Journal of Epidemiologyand organizes the World Congress ofEpidemiology. At the national level, we also havethe National Epidemiology Network (JEN). The fieldof epidemiology also benefits from authoritative textbooks,such as those written by Kenneth J Rothman.For clinical research, there is the International Clinicalepidemiology network and the field benefits fromauthoritative textbooks such as those written by DavidSackett or Robert Fletcher. At the national level, theIndonesian Clinical Epidemology and EvidenceBased Medicine Network has also been established.We are looking forward to work with the healthservice management research community to moveforward with strengthening health service managementresearch as a scientific endeavour.